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Multicultural Counseling

and the Orthodox Jew


Eliezer Schnall
The cultural diversity literature largely ignores the effects of religion, and especially Judaism, on counseling and
psychotherapy. The author reviews the meager and mostly anecdotal accounts relating to Orthodox Jews in the
literature of several related disciplines, including counseling, social work, psychology, and psychiatry. The objective is to identify the barriers, institutional and personal, that must be overcome before the Orthodox Jew can
receive adequate mental health care and to suggest recommendations for clinical practice.

Research suggests that minority groups tend to underutilize


mental health services provided by the majority culture, and
even those who do enter psychotherapy often terminate prematurely (Margolese, 1998). Orthodox Jews are no exception. When surveyed, 90% of Orthodox mental health professionals reported that the mental health needs of their community are poorly met (Feinberg & Feinberg, 1985).
Wikler (1989) pointed out that the cultural diversity literature has usually ignored the effects of religion, and certainly
Judaism, on psychotherapy (see also Wieselberg, 1992). Even
the field of counseling, although styling itself as especially
sensitive to issues of diversity (American Counseling Association [ACA] Mission Statement, 2005, Bylaws, Article 1,
Sec. 2) has disappointingly chosen to mostly ignore the needs
of Jews. According to Arredondo and DAndrea (1999), Jews
have been largely attributed an invisible status in the fields of
counseling and psychology in general and within the
multicultural counseling movement in particular (p. 14).
A thorough review by Langman (1999) found that
multiculturalism has typically not included Jews and
books, journals, classes, and conferences [in counseling
and psychology] make little mention of Jews, Jewish issues,
or anti-Semitism (p. 2). In a review, published in ACAs
flagship publication, the Journal of Counseling & Development, Weinrach (2002) observed that the counseling diversity literature fails even to recognize the notion of Jews
as a culturally distinct group (p. 300). He further presented
substantial and compelling evidence to support his assertion that the treatment of Jews and Jewish issues within the
counseling profession suggests a disturbing pattern of antiSemitism (p. 303).
This tradition of neglect especially compromises the efficacy of those mental health professionals who treat Orthodox
Jews but who lack the research studies that would guide them.

Indeed, there are no scientifically rigorous studies that examine psychotherapy with Orthodox Jews (Margolese, 1998,
p. 38). Ironically, Bilu and Witztum (1993) suggested that
transcultural therapy involving this group is more complex
than with any other diverse group. Moreover, there is evidence that Orthodox Jews, and particularly the newly religious, suffer increased rates of severe psychiatric disorders
(Bilu & Witztum, 1993) and are increasing as a proportion of
Jews entering psychotherapy (Wikler, 1986). Their numbers
in therapy are almost certain to continue rising, because their
community is presently awakening to the reality of their
mental health needs (Lightman & Shor, 2002; Shaviv, 2002;
B. Twerski, 2002) and experiencing a dramatic (Sorotzkin,
1998, p. 94) increase in readiness to accept help from the
mental health profession in meeting those needs.
As with any minority group, there are circumstances when
it may be beneficial or time-saving for the Orthodox Jew
simply to engage a counselor or therapist who shares similar
religious beliefs and cultural values (Simmons, 2001), yet
there are few available (Bilu & Witztum, 1993). Furthermore, even when they are available, they may represent a
poor choice for the patient. For example, even a slight variation in religious commitments may trigger suspicion on the
part of one or the other. In addition, countertransference
arising from the Orthodox professionals own unresolved
religious conflicts may complicate matters (Rabinowitz,
2000). Moreover, university-educated Orthodox Jews are
sometimes outright hostile to their more traditional
coreligionistsor may be suspected by the client of being
such a traitor (Bilu & Witztum, 1993; Greenberg, 1991).
Given the frequent complexity of using an Orthodox Jewish counselor or therapist, and their relative scarcity, the
option of a non-Orthodox or non-Jewish one must be considered. Indeed, many mental health professionals suggest

Eliezer Schnall, Psychology Department, Yeshiva University. This article is dedicated to the authors parents, David and Tova
Schnall, for their love and support. He is also grateful to Sharon Brennan and William Di Scipio for their encouragement on this
project. Finally, the author acknowledges the late Stephen Weinrach, whose work was an inspiration for this article. Correspondence concerning this article should be addressed to Eliezer Schnall (e-mail: eschnall@aol.com).

2006 by the American Counseling Association. All rights reserved.

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that with proper training, this is feasible (Buchbinder, 1994;


Sublette & Trappler, 2000). Although there are Orthodox
Jewish leaders who have resisted the idea, the late Rabbi
Moshe Feinstein (as cited in Greenberg & Witztum, 1994a),
widely regarded as a leading contemporary Jewish rabbinical authority, ruled that when necessary, and if appropriate
guidelines are in place, Jews may seek help from a psychotherapist who would be viewed, from a religious perspective, as a heretic or atheist (p. 143). In fact, Wikler (1989)
found that only 45% of Orthodox Jewish clients actually preferred an Orthodox therapist, whereas the majority requested
other therapists or voiced no preference at all. Unfortunately,
therapists culturally competent to work with Orthodox Jews
are rare (Buchbinder, 1994).
Weinrach (2002) called for the counseling field to develop a literature on the topic of Jewish needs as a step
toward rectification of the disregard it has shown thus far.
The present article aims to contribute to that goal by drawing together the meager and mostly anecdotal accounts
about Orthodox Jews in the literature of several related disciplines, including counseling, social work, psychology, and
psychiatry. The objective is to identify for counselors and
psychotherapists the barriers, institutional and personal,
that must be overcome before the Orthodox Jew can access
appropriate mental health care and to suggest recommendations for clinical practice.

Description of the Population


The term Orthodoxy was first applied in 1807 when Napoleon emancipated the Jews from the ghettos. It referred to
Jews who accepted the fullness of Jewish law and tradition
(Kahn, as cited in Strean, 1994, p. 8). More specifically, Orthodox Jews accept that G-d gave the Torah, the Hebrew Bible,
to the People of Israel at Mount Sinai, along with a divinely
ordained interpretation of its commands. They apply these
Biblical precepts to all matters, including family life, business dealings, and the many rituals of prayer and service. (For
a historical context of this population, see Rabinowitz, 2000.)
Although population estimates are, for many reasons,
difficult to make, it has been suggested that there are between 5.2 and 6.7 million Jews in the United States, if the
strict Orthodox definition of Jewishness is used (Cohen,
2002). Although the Orthodox constitute only a small minority
of the Jewish population, they tend to live in concentrated
areas, and Wikler (2001) estimated that there might be approximately 250,000 Orthodox Jews in the New York metropolitan area alone. There are also relatively large Orthodox
populations in other major North American cities such as
Baltimore, Chicago, Los Angeles, Miami, and Toronto.
It must be emphasized that Orthodox Jewry is a diverse
group, with many subgroups, and that members of the subgroups differ to a greater or lesser degree in their language,
diet, worldview, dress, and even religious practice. While these

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differences may, at times, be imperceptible to outsiders, members of the subgroups take them very seriously (Wikler, 2001).
The most traditional Orthodox Jews are sometimes called
Ultra-Orthodox, as opposed to modern Orthodox. Although such labeling may seem convenient to researchers, many within that community find it offensive and
insulting (Lightman & Shor, 2002; Weill, 1995.) Furthermore,
in categorizing, one implies that the Ultra and modern Orthodox are distinct and form homogenous groups. Actually, Orthodox Jewry forms a spectrum and cannot easily be divided
into neatly defined segments. Even if such terminology were
accurate, it might actually serve to confuse clinicians because
within a single family it is not uncommon to find modern
Orthodox parents whose children hold Ultra-Orthodox views,
often because these parents selected Ultra-Orthodox institutions for their childrens education.
To avoid misleading and offensive labels, I simply refer
to Orthodox Jews, although original sources may have attempted to be more specific. As a guideline, however, when
counseling Orthodox Jews who are more culturally and religiously identified, the issues raised in this article are likely
more relevant than when counseling those who are more
modern. In any event, as with all cultural diversity literature, the reader is cautioned against making assumptions
about every individual Orthodox Jewish client. The intent
is to highlight the issues a therapist or counselor may encounter with this population.

Institutional Barriers
Certain characteristics of the Western mental health care
system as it is presently organized are incompatible with the
needs of the Orthodox Jewish community. As a result, it
becomes less likely that members of this group will seek or
receive adequate care. These institutional barriers are the
focus of the present section.
To the Orthodox Jew, seeking psychological help may
seem to reveal personal weakness. He or she may view it as
admitting that Orthodox Judaism does not have all the answers (Strean, 1994, p. 39). Furthermore, members of this
group may be under the impression that Jews are high
achievers, and shouldnt (Zedek, 1998, p. 260) require
the assistance of mental health practitioners.
The fact that therapists and counselors are university educated indirectly contributes to another problem. Many Orthodox Jews view mental health workers as representatives of the
unchaste and decadent secular world from which they try to
isolate themselves and their families (Bilu & Witztum, 1993).
They assume that these professionals will challenge their values and possibly even attempt to deconvert (Heilman &
Witztum, 1997, p. 523) them from religious belief.
Orthodox Jews may also fear that counselors and therapists
will not respect values that are important to their community
(Sublette & Trappler, 2000). For example, there may be con-

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cern that the secular professional will disregard the domestic tranquility of the family unit (shalom bayis) or will be
quick to report problems to the governmental authorities
that their community prefers to deal with internally
(Lightman & Shor, 2002). Tens of centuries of persecution
and pogroms, culminating with the Nazi Holocaust, have
led many Jews to be suspicious of outsiders, wondering
whether they may be anti-Semitic or have ulterior motives
(Sublette & Trappler, 2000; Zedek, 1998), and those with
the strongest commitments to Judaism may be the most likely
to exhibit this suspicion. Finally, Orthodox Jews may fear
that therapy will require interaction with members of the
opposite sex in ways discouraged or prohibited in their culture and tradition.
The many rabbinic responsa (as cited in Greenberg &
Witztum, 1994a) that discourage dealing with secular mental health professionals only serve to underscore this mistrust on the part of Orthodox Jewish clients. Moreover, classical Jewish texts are often critical of the medical profession
generally (Margolese, 1998). Greenberg (1991) observed that
the modern Hebrew term for psychiatry is briyut nefesh and
that the latter word literally translates as soul, a word with
religious and Kabbalistic mystical overtones, which may
confuse Hebrew-speaking Orthodox Jews. They will likely
wonder how a non-Jewish or irreligious counselor or therapist, using secular knowledge, can understand a metaphysical entity like the Jewish soul.
It should also be noted that many Orthodox Jews turn
first to a rabbi if they have social or emotional difficulties.
Results of a survey conducted by Wikler (1986) found very
few instances where Orthodox Jews in therapy had been sent
by their rabbis. Presumably, rabbis were discouraged from
referring to psychotherapists because of the same factors
that discourage Orthodox Jews generally from seeking help
from psychotherapists.
Many Orthodox Jews also claim that their community
attaches a stigma to those receiving psychological help
(Feinberg & Feinberg, 1985). They fear that anyone who
learns of their situation will consider them crazy or insane (Wikler, 1986, p. 117). This stigma is compounded by
the importance Orthodox Jews place on family background
when considering a partner for marriage, which is often
wholly or partially arranged after careful investigation
(Rockman, 1994a). As such, Orthodox Jews often fear that
by seeking therapy they are ruining their siblings or
childrens chances of finding a suitable match or, needless
to say, their own (shidduch anxiety; Greenberg, 1991;
Margolese, 1998; Sublette & Trappler, 2000; Wikler, 1986).
Furthermore, the close-knit nature of their communities
makes it difficult to keep such things a secret.
Although some of the previously discussed issues may
be unique, many Orthodox Jews must overcome another barrier to mental health care commonly encountered by other
minority groups. Often because they have chosen religious

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study and service as their primary goal in life, a significant


portion of Orthodox Jews are f inancially pressed
(Buchbinder, 1994; Feinberg & Feinberg, 1985). Without
adequate funds, attaining high-quality care is difficult.

Barriers to Multicultural Competency


Perhaps the most daunting challenge facing a counselor or
therapist who works with Orthodox Jews is that there are so
many different subgroups, each with different customs,
worldviews, and religious practices (Greenberg, 1991; Paradis,
Friedman, Hatch, & Ackerman, 1996; Wikler, 2001). For that
reason, it is also difficult to provide a comprehensive list of
issues relevant to the clinician who wishes to become culturally competent with this clientele. As such, this section is
meant as a guide to the practitioner, who is cautioned about
making assumptions regarding specific clients.
To be sure, many of the issues applicable to other examples of cross-cultural counseling or therapy are relevant
to Orthodox Jews as well. Thus, the clinician and client may
have different ideas about the appropriate amount of interpersonal space. They may also be accustomed to using different body movements or facial expressions, or they may
use language differently (Greenberg, 1991). To further complicate matters, some Orthodox Jews speak Yiddish or Hebrew as their first or primary language.
As mentioned earlier, the Orthodox Jewish community
often attaches a stigma to individuals receiving mental
health services, making it difficult for them to find suitable
marriage partners. In this vein, Wikler (1986) cautioned social workers to expect an unusually strong interest in confidentiality on the part of the client. They should appreciate
the great resistance and risk that the Orthodox client overcame in seeking therapy and not mistake his or her behavior
for paranoia. In the case of older Orthodox singles who often
suffer shame at being unmarried, Wiklers (1986) warning is
even more pertinent. Furthermore, encouraging clients to
speak about their disorder with friends or even relatives, or
to join support groups, may adversely affect their standing
in their community (Paradis et al., 1996).
Counseling the Orthodox Jewish client in matters relating to family planning is also complex. For example, encouraging a client to delay or cease childbearing due to the
stress that a large family can cause will often be resisted
because of the Biblical injunction to Be fruitful and multiply (Genesis 1:28), coupled with a desire to replace relatives
murdered in the Holocaust. In this case, value-sensitive
therapy (Heilman & Witztum, 1997, p. 522) presumably includes helping the client deal with the stress of a large family
rather than discouraging his or her raising one (Paradis et al.,
1996; Sublette & Trappler, 2000).
Commonly, therapy involves asking a client to discuss
significant others in his or her life. Yet Orthodox Jews may
be reluctant to convey any uncomplimentary information.

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In the case of discussing parents, for example, they will fear


breaking the Biblical injunction to Honor thy father and thy
mother (Exodus 20:12). Even speaking about acquaintances or
coworkers may be difficult for a client, given the general prohibition (e.g., Leviticus 19:16) against slander and gossip (Paradis
et al., 1996; Rabinowitz, 2000; Sublette & Trappler, 2000).
When working with this population, even the most
innocuous-sounding suggestions must be carefully considered. For instance, encouraging a young boy to become involved with sports to siphon off aggressiveness may not be
accepted by parents and teachers, because they may be concerned about the time it will take from his studies (GoshenGottstein, 1987). Examples in a milieu setting include
encouraging a patient to watch television or join mixedgender groups, both of which may lead to resistance based
on religious beliefs that will likely be misunderstood by
clinic staff (Margolese, 1998; Silverstein, 1995).
Assessing intelligence or dementia in Orthodox Jews
by asking certain common questions may also be problematic. Because of their relative social isolation, some are
unfamiliar with events in the secular world, and this isolation and its consequences can serve to emphasize therapist
client differences, perhaps resulting in the clients suspicion
or derision of the therapist. Greenberg (1991) recommended
asking instead about Jewish religious festivals or the
weekly Torah reading. Unfortunately, a culturally competent assessment instrument has not yet been devised for
this population.
To further complicate matters, Western-educated professionals may profess different explanatory models of illness
than do their clients. For example, some clients may view
difficulties, even psychological or emotional ones, as G-ds
reproof for nonadherence to religious laws. Others may understand difficulties as divine tests to evaluate whether they
use the opportunity to repent (Margolese, 1998).
Similarly, symptoms may be colored with religious
themes, such as hallucinations containing mystical elements
(Bilu & Witztum, 1993; Greenberg & Brom, 2001; Witztum,
Greenberg, & Buchbinder, 1990). Furthermore, Orthodox Jews
may experience obsessions or compulsions that relate to
observance of Jewish laws of purity, prayer, or dietary requirements (Bilu & Witztum, 1993; Burt & Rudolph, 2000;
Greenberg & Witztum, 1994b; Hoffnung, Aizenberg,
Hermesh, & Munitz, 1989). It can thus be daunting for someone not multiculturally competent to differentiate normative religious practice from aberrant behavior.
As alluded to earlier, the rabbi plays an important role in
the lives of Orthodox Jews. He is well respected, and many
will turn to him for direction even regarding matters seemingly unrelated to religion (Goshen-Gottstein, 1984); of
course, for the Orthodox Jew, religion permeates all areas of
life. This rabbinical involvement has many ramifications for
therapy. For example, a client who seeks psychological counseling on the advice of his rabbi may view the encounter as

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fulfillment of the religious obligation to heed rabbinic directives. The clinician may thus be surprised that the apparently motivated client displays little desire to engage in the
work of the counseling or therapy itself (Rabinowitz, 2000).
In addition, Orthodox Jewish clients who have never engaged in any form of psychotherapy may bring with them
some very unhelpful preconceptions. They likely have had
experience discussing a variety of issues with their rabbis,
who often supply a teshuva, or response, to a posed
sheela, or question. This type of interchange differs
markedly from the self-exploration often encouraged in
therapy, which may disappoint a client who has different
expectations (Greenberg, 1991).
Western-trained mental health professionals may have
particular difficulty counseling Orthodox Jewish women,
whose role in the family is easily misunderstood. Although
they may have jobs, these women are often uninterested
in, or discouraged from, careers, and their primary roles
are seen as wife, mother, and homemaker (Goshen-Gottstein,
1984). However, contrary to what that situation may mean to
the counselor or therapist, at least ideally, the Orthodox Jewish woman is seen as complementary, not subordinate, to her
husband (Margolese, 1998). As the Talmud (Tractate
Sanhedrin) states, A husband must love his wife as himself
and honor her more than himself (folio 28).
Outsiders may also misunderstand other aspects of Orthodox Jewish spousal relations. To some within this community, the terms love, romance, and sex life may have little
relevance, because they view marriage primarily as a means
to raise a family. That does not mean that husbands and
wives do not share intimacy and affection, but it does mean
that their definition of marriage may differ substantially
from the definition common in Western society (GoshenGottstein, 1987). Like almost every area of Orthodox Jewish
life, sexual relations are guided by strict laws, which, if unfamiliar to the therapist, will substantially complicate marital
therapy. (See especially Lamm, 1966. Ostrov, 1978, may also
be helpful. Rockman, 1994b, provided a thorough summary
of the topic, although inaccurate on at least one point.)
The issue of countertransference is also important when
working with this population. Like all minorities, Orthodox
Jews are often seen as being inferior by the majority culture.
Even Orthodox Jews, and certainly the non-Orthodox, may
feel antagonism toward the most traditional Orthodox Jews
who have chosen to study full-time in place of a normal
occupation. This is particularly poignant in Israel, where
many secular Jews feel that those Israelis who do not serve
in the army or work for a living are leeches on the rest of
society (Greenberg, 1991).
Some Jewish mental health workers may also suffer embarrassment at the perception that they are identified with
the backward Orthodox clients by their non-Jewish colleagues. In addition, counselors and therapists of all types
may make the mistake of trying to replace religion with

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psychotherapy, while actually each serves different personal


needs (Rabinowitz, 2000). Others, especially non-Jews, may
instead be overly deferential toward religious customs, not
realizing that a given behavior is actually pathological or
defensive even by religious standards (Ostrov, 1976; Sublette
& Trappler, 2000).

Recommendations for Clinical Practice


Perhaps the most important recommendation for mental health
care workers wishing to serve Orthodox Jews is to liaise with
rabbis and other leaders of their community (Sublette &
Trappler, 2000). This contact will garner credibility and legitimacy (Greenberg, 1991) and help to develop working relationships with the local rabbis. Indeed, referral from a rabbi
may be the only way many Orthodox Jews will seek psychological help (Bilu & Witztum, 1993). Furthermore, Orthodox
rabbis are usually very concerned about the mental health of
their congregants (Margolese, 1998) and can be a resource
throughout treatment (Zedek, 1998).
For example, consultation with an Orthodox rabbi will
prevent the clinician from suggesting activities that conflict with his or her clients religious views (Buchbinder,
1994; Ostrov, 1976). Conversely, there may be times when a
client does not realize the great flexibility and leniency of
Jewish law, particularly where medical necessity is concerned.
For example, Paradis et al. (1996) described the case of a
patient who refused to take medication on Jewish fast days.
When contacted, his rabbi explained that the medication
was permissible to consume under the circumstances.
Similarly, Hoffman (2001) described instances where there
is rabbinic dispensation to set aside the requirement of
Honor thy father and thy mother in favor of the mental
health needs of the given client. It is thus critical to question
the clients rabbi whenever Jewish law seems to conflict with
therapeutic needs. (For another possible example, see Spero,
1980, chap. 10.) In addition, a rabbis guidance is likely
necessary in determining whether a clients behavior is within
normative religious bounds or is symptomatic of obsessivecompulsive disorder (Paradis et al., 1996).
Bilu and Witztum (1993) mentioned the importance of
learning the customs and mannerisms of Orthodox patients
in order to know how to put them at ease. As mentioned
earlier, these vary widely and depend on the subgroup in
question. Paradis et al. (1996) provided a helpful glossary of
Jewish holidays and other relevant terms, which can serve as
background prior to more comprehensive study.
Rabinowitz (2000) explained how traditional Jewish
thought can be incorporated into psychological treatment.
For example, unlike the doctrine of original sin as understood by certain Christian groups, Jews believe that people
are born with the opportunity to remain in a state of virtue
and purity. Even if one strays from the proper path, there is
always the chance to repent (Zedek, 1998), referred to as

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Teshuva. This concept, familiar to all Orthodox Jews, may


be useful in that it discourages despair, because there is always the ability to change.
In addition, accentuating the cardinal principle that G-d
must be served with joy (Deuteronomy 28:47, Psalms 100:2)
may help motivate a depressed patient to comply with treatment. Many classical Jewish works, such as those of Rabbi
Nachman of Breslov who is famous for having emphasized
joyousness, have been translated and/or summarized in English (e.g., Kramer, 1989) and may be helpful as part of
therapy. In addition to classical Jewish writings, sessions or
homework might also incorporate readings from certain contemporary Orthodox Jewish authors who use traditional Jewish thought in encouraging psychological and emotional
well-being (e.g., Pliskin, 1983; A. Twerski, 1987).
When working with this population, it may also be advisable to frame explanations and ideas in religious terms. For
example, reminding the client that a healthy mind is necessary to serve G-d makes therapy more compelling. Calling
irrational and inappropriate ideas the Yetzer Harah (evil
inclination) will make the concepts more familiar. Optimism can be explained as Bitachon (i.e., trust in G-d
that all will be for the best; Buchbinder, 1994).
Some clinicians have actually incorporated Jewish ritual
into therapy. For example, Abramowitz (1993), a social worker,
described how prayer is used as therapy for frail older Jews.
Bilu and Witztum (1993), both psychiatrists, described several
very creative adaptations of Jewish ritual that have been successfully added to the treatment of even the most severely
psychotic Orthodox Jewish patients.
Although there may be resistance on the part of Orthodox Jews toward psychotherapy, especially psychoanalysis
(Rabinowitz, 2000), there is far less resistance toward biomedical science. Thus, a biological model of mental illness
is often more readily accepted (Greenberg & Witztum, 1994a;
Margolese, 1998; Trappler, Greenberg, & Friedman, 1995.
See, however, Bilu & Witztum, 1993). Similarly,
psychopharmacotherapy may be preferred to psychotherapy
(Greenberg, 1991). When this seems to be the case, referral
to a psychiatrist may be the best option.
There are also many seemingly trivial details that may
help Orthodox Jewish patients feel more comfortable in
therapy sessions. For example, Bilu and Witztum (1993)
described the location and decoration of their clinic, both
intended to make the environment seem less alien to their
Orthodox clientele. Probably even more critical is that all
visible clinic staff members abide by a modest dress code.
This is especially important for female staff, who should
avoid apparel such as short skirts and sleeveless or low-cut
shirts. Sometimes a same-sex clinician may be necessary to
further limit anxiety and facilitate a therapeutic alliance
(Silverstein, 1995; Sublette & Trappler, 2000). Sexual boundaries should be carefully observed, perhaps even more strictly
than required by professional guidelines (Buchbinder, 1994).

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Even shaking hands with an opposite-sex Orthodox client


may be very problematic.
Although it is usually suggested that mental health centers be located within minority communities, many Orthodox Jews may actually benefit from referral to a remote
clinic, given their extreme interest in confidentiality
(Sublette & Trappler, 2000). It is also judicious not to schedule Orthodox Jews for consecutive sessions, because they
may be very uncomfortable meeting a member of their community in such a location (Margolese, 1998; Paradis et al.,
1996). Bilu and Witztum (1993) also suggested a general
flexibility with appointment times as a way to increase compliance when dealing with members of this group, who may
feel ambivalent about attendance.
As previously mentioned, a significant portion of the
Orthodox population is financially pressed, often because
they have chosen to eschew more lucrative careers in favor
of a life revolving around religious study, teaching, or the
clergy. For this reason, Feinberg and Feinberg (1985) suggested using a sliding scale when determining the clinicians
fee. Buchbinder (1994) suggested using a short-term treatment approach in order not to put further financial strain on
these clients.
Although a general sensitivity for cultural diversity is helpful in working with Orthodox Jews (Buchbinder, 1994), specialized training has been useful in sensitizing professionals
to issues specific to this population (Sublette & Trappler, 2000.
See also Long Island College Hospital, 2002). Unfortunately, there are very few programs that provide such specialized training, even in areas with substantial Orthodox Jewish
populations. As an alternate, Bilu and Witztum (1993) recommended using a team approach, with at least one member of
the team having expertise in the patients culture. In addition,
they suggested having the client invite a chaperon who would
act as the cultural bridge, a strategy that has been successful
with other minority group members.
Therapists and counselors who wish to work with this, or
any, minority population are also advised to develop an appreciation for the groups way of life. For example, although an
Orthodox Jewish lifestyle may place certain stresses on an individual, it also contains many supportive elements (Bilu &
Witztum, 1993). Furthermore, religious commitment in general
has been shown to have a positive association with mental
health. Goshen-Gottstein (1987) pointed out that in Geula, a
strictly Orthodox community in Jerusalem, Israel, there are no
violent crimes such as murder, rape, assault or burglary (p.
160). There is also evidence that Jewish texts taught in Orthodox schools more effectively encourage the development of
advanced cognitive skills than does modern secular education
(Dembo, Levin, & Siegler, 1997). Therapists and counselors
should also consider that religious difficulties may be effects
of, and not causes of, emotional difficulties (Margolese, 1998).
As with all cross-cultural counseling and psychotherapy,
it is most critical for professionals interacting with Ortho-

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dox Jews to treat clients and their community with respect


and sensitivity (Rabinowitz, 2000). When Greenberg (1991)
asked one Orthodox rabbi what type of therapist was necessary for an Orthodox client, he was told, What matters most
is that he understands the religious way of life and respects
each person with their outlook (p. 27). In that way, diverse
groups may be more the same than they are different.

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